Individual
SHANNON D LOTT
Active
Individual
SHANNON D LOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
N5204
TX
207L00000X
Anesthesiology Physician
TL1104
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218796501
—
TX
01
—
8CL591
BLUE CROSS BLUE SHIELD
TX
01
—
P00891218
RR MEDICARE
TX
Enumeration date
06/11/2007
Last updated
08/24/2018
Update your record
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